Natriuretic Peptides as Biomarkers: Narrative Review and Considerations in Cardiovascular and Respiratory Dysfunctions.

Natriuretic peptides (NPs) encompass a family of structurally related hormone/paracrine factors acting through the natriuretic peptide system regulating cell proliferation, vessel tone, inflammatory processes, neurohumoral pathways, fluids, and electrolyte balance. The three most studied peptides are atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-Type natriuretic peptide (CNP). ANP and BNP are the most relevant NPs as biomarkers for the diagnosis and prognosis of heart failure and underlying cardiovascular diseases, such as cardiac valvular dysfunction, hypertension, coronary artery disease, myocardial infarction, persistent arrhythmias, and cardiomyopathies. Cardiac dysfunctions related to cardiomyocytes stretching in the atria and ventricles are primary elicitors of ANP and BNP release, respectively. ANP and BNP would serve as biomarkers for differentiating cardiac versus noncardiac causes of dyspnea and as a tool for measuring the prognosis of patients with heart failure; nevertheless, BNP has been shown with the highest predictive value, particularly related to pulmonary disorders. Plasma BNP has been reported to help differentiate cardiac from pulmonary etiologies of dyspnea in adults and neonates. Studies have shown that COVID-19 infection also increases serum levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) and BNP. This narrative review assesses aspects of ANP and BNP on their physiology, and predictive values as biomarkers. We present an overview of the NPs' synthesis, structure, storage, and release, as well as receptors and physiological roles. Following, considerations focus on ANP versus BNP, comparing their relevance in settings and diseases associated with respiratory dysfunctions. Finally, we compiled data from guidelines for using BNP as a biomarker in dyspneic patients with cardiac dysfunction, including its considerations in COVID-19.

Identifying Risk Factors for Complication and Readmission with Same-Day Discharge Arthroplasty.

BACKGROUND: The COVID-19 pandemic caused a surge of same-day discharge (SDD) for total joint arthroplasty. However, SDD may not be beneficial for all patients. Therefore, continued investigation into the safety of SDD is necessary as well as risk stratification for improved patient outcomes. METHODS: This retrospective cohort study examined 31,851 elective SDD hip and knee arthroplasties from 2016 to 2020 in a large national database. Logistic regression models were used to identify patient variables and preoperative comorbidities that contribute to postoperative complication or readmission with SDD. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated. RESULTS: SDD increased from 1.4% in 2016 to 14.6% in 2020. SDD is associated with lower odds of readmission (AOR: 0.994, CI: 0.992-0.996) and postoperative complications (AOR: 0.998, CI: 0.997-1.000). Patients who have preoperative dyspnea (AOR: 1.03, CI: 1.02-1.04, P < .001), chronic obstructive pulmonary disease (AOR: 1.02, CI: 1.01-1.03, P = .002), and hypoalbuminemia (AOR: 1.02, CI: 1.00-1.03, P < .001), had higher odds of postoperative complications. Patients who had preoperative dyspnea (AOR: 1.02, CI: 1.01-1.03), hypertension (AOR: 1.01, CI: 1.01-1.03, P = .003), chronic corticosteroid use (AOR: 1.02, CI: 1.01-1.03, P < .001), bleeding disorder (AOR: 1.02; CI: 1.01-1.03, P < .001), and hypoalbuminemia (AOR: 1.01, CI: 1.00-1.02, P = .038), had higher odds of readmission. CONCLUSION: SDD is safe with certain comorbidities. Preoperative screening for cardiopulmonary comorbidities (eg, dyspnea, hypertension, and chronic obstructive pulmonary disease), chronic corticosteroid use, bleeding disorder, and hypoalbuminemia may improve SDD outcomes.

[Platypnea-orthodeoxia syndrome secondary to pneumonia: Two cases]. / Syndrome platypnée-orthodéoxie secondaire à une pneumopathie : à propos de deux cas.

INTRODUCTION: The platypnea-orthodeoxia syndrome is a rare situation characterized by the appearance of dyspnea and/or hypoxemia during the transition to orthostatism. OBSERVATIONS: We report the case of two patients, who presented with a platypnea-orthodeoxia syndrome following pneumocystis pneumonia and COVID-19, revealing an intracardiac communication with a right-left shunt on contrast ultrasound. CONCLUSION: This syndrome can be detected easily at the bedside with positional maneuvers and the shunt demonstrated by a hyperoxia test. Non-reversible situations may require correction of the anatomical anomaly by transcatheter intervention or surgery.

[Capacity of vibroacoustic therapy for correction of respiratory manifestations of post COVID-19 syndrome]. / Vozmozhnosti vibroakusticheskoi terapii v korrektsii respiratornykh proyavlenii postkovidnogo sindroma.

The search for therapeutic strategies for the correction of post COVID-19 syndrome is an urgent task of medicine. One of the frequent manifestations of post COVID-19 syndrome is the prolonged persistence of respiratory syndromes - dyspnea and cough. Vibroacoustic therapy is promising methods in the complex effect on broncho-pulmonary symptoms of COVID-19. OBJECTIVE: To study the effect of vibroacoustic pulmonary therapy implemented through the BARK VibroLUNG apparatus on the clinical and instrumental parameters of patients undergoing COVID-19 with residual respiratory symptoms. MATHERIAL AND METHODS: The effect of vibroacoustic therapy (5-day course of 2 sessions) on dyspnea and cough and respiratory function in 60 patients aged 18 to 75 years who underwent COVID-19 of varying severity for more than 12 weeks before the start of the study, with the presence of distant respiratory symptoms, was investigated. Patients were divided into two equal and age-matched groups - without (1st) and with (2nd) chronic bronchopulmonary pathology. RESULTS: Analysis of comorbidity of patients with respiratory phenotype of post COVID-19 syndrome showed frequent presence of concomitant cardiovascular pathology (76.7%). The predominant patient complaint was dyspnea (93.3% in both groups): 29 patients (96.7%) in the non-lung group, and 27 patients (90%) in the chronic lung group. The mean mMRC dyspnea score for all patients was 1.1±0.49 points (1.2±0.5 points in the first group and 1.0±0.45 points in the second group). Cough was observed less often - in 18 patients of both groups (30%), mainly in the second group. During the course of vibroacoustic therapy in the 1st group, the number of patients with dyspnea decreased from 96.7 to 30%, in the 2nd group - from 90 to 10%, the total mean mMRC dyspnea score decreased to 0.2±0.4 (Δ 82%), and a complete regression of cough syndrome was achieved in both groups. Also, an increase in forced expiratory volume in 1st second and peak expiratory flow indicators was revealed both in the general group of patients and in the group of patients without chronic lung pathology. CONCLUSION: The results obtained during the study of the use of vibroacoustic therapy in patients with respiratory manifestations of post-COVID syndrome, including the presence of chronic bronchopulmonary pathology, allow us to conclude on the effective correction of dyspnea and cough during treatment. Vibroacoustic therapy is a promising non-drug method of exposure to bronchopulmonary manifestations of post-COVID syndrome in patients during rehabilitation.

Characteristics and outcomes of severe COVID-19 in hospitalized patients with cardiovascular diseases in the Amazonian region of Brazil: a retrospective cohort.

The northern region of Brazil is already vulnerable to other infectious diseases and it was no different in COVID-19. However, cardiovascular diseases still lead the causes of death. Thus, the objective of this study is to identify the clinical predictors and outcome of severe COVID-19 in hospitalized patients with and without CVD in this region of the Amazon. A retrospective cohort, referring to the notifications from January 1 to December 31, 2020, including cases confirmed by molecular testing. The study consisted of 9223 confirmed cases for COVID-19. Of these, 6011 (65.17%) did not have cardiovascular disease and 3212 (34.83%) had some cardiovascular disease. The significance of deaths was in the age group of < 1 to 59 CVD carriers (< 0.001). Predictor of mortality were invasive ventilation for patients with CVD, (OR 23,688 CI 18,180-30,866), followed by chronic kidney disease (OR 2442 CI 1568-3740), dyspnea (OR 2312 CI 1817-3941), respiratory distress (OR 1523 CI 1210-2919), cough (OR 1268 CI 1005-1599), Lower oxygen saturation 95% (OR 1281 CI 1039-1579), diabetes mellitus (OR 1267 CI 1050-1528) and age (OR 1051 CI 1044-1058). Carriers of CVD had a lower survival rate (< 0.0001). The order of the predictors of death differed among the non-carriers, as well as the high odds ratio in the predictors of CVD, only cough was an independent predictor. The age group under 59 years was associated with deaths. We also show the shorter survival in CVD carriers, as well as the higher cardiovascular morbidity rate than other studies in the literature.

Diagnostic Model of COVID-19 Infection Based on the Combination of Clinical Symptoms, Chest Radiography and Laboratory Test.

BACKGROUND: COVID-19 is an infection caused by SARS-COV 2.For screening the patient, Rapid antigen for COVID-19 is used with a high diagnostic value. However, there are still some cases of false-negative even with clinical symptoms suggesting COVID-19. Undetected COVID-19 patients certainly will increase  transmission. A simple and practical diagnostic model, using determining factors, is required to guide physicians through a quicker decision making process, especially when deciding the need for the isolation rooms for patients with COVID-like symptoms. METHODS: This study is a cross-sectional study. The study was conducted at CiptoMangunkusumo Hospital, Jakarta.History of contact with COVID-19, clinical symptoms, laboratory examination, and chest radiograph data were taken from medical records. Bivariate and multivariate analyses were conducted to assess the effect sizes of patient factors on the diagnostic results.ROCcurve and Hosmer-Lemeshow calibration was used to make the scoring. RESULTS: There were 187 patients with the majority of subjects in the age group < 60 years old. The selected variables in this scoring systemwere contact history,fever/history of fever, dyspnea with respiratory rate >20 breaths/minute, leucocyte ≤ 10.000 cells/mLand typical chest radiography. The area under the curve for this model was 0,777 (CI95% (0,706-0,847), P<0,001). The probability was 82% with a cut-off point ≥ 4. CONCLUSION: Determinant models based on the combination of contact history, presence or history of fever, dyspnea, leucocyte count ≤ 10.000 cells/mL and typical chest radiography provides good accuracy to aid physicians in managing isolation room needs for patients with suspected COVID-19.

Efficacy of Liriope platyphylla extract on improving respiratory function: A CONSORT-randomized, double-blind, placebo-controlled pilot trial.

BACKGROUND: The respiratory system is the first line of defense against outside pollutants. Recently, respiratory health has been receiving increasing attention due to the increase in fine dust, which reduces respiratory function and increases incidence of chronic obstructive pulmonary disease, and in coronavirus pandemic, which can cause severe acute respiratory syndrome. METHODS: This clinical pilot trial was designed to secure evidence for a main clinical trial and to confirm the efficacy and safety of Liriope platyphylla (LP) extract for improving respiratory function. We conducted a double-blind randomized placebo-controlled trial with 22 participants from June 30, 2021, to August 25, 2021. The primary outcome was Breathlessness, Cough, and Sputum Scale score. Secondary outcomes included forced vital capacity, forced expiratory volume at 1 second (FEV1), forced expiratory volume at 1 s/forced vital capacity ratio, cough assessment test score, chronic obstructive pulmonary disease assessment test score, peripheral blood mononuclear cell counts (white blood cells, eosinophils, T cells, and B cells), high-sensitivity C-reactive protein level, erythrocyte sedimentation rate, cytokine (interleukin-1ß, interleukin-4, tumor necrosis factor-α, interleukin-6, interleukin-8, interferon-γ, and immunoglobulin E) levels, antioxidant (glutathione peroxidase and superoxide dismutase) levels, and nitric oxide level. RESULTS: A total of 22 participants were randomly assigned to 2 groups: the LP group (n = 11), who took 1000 mg of LP extract per day, and the placebo group, who took 1000 mg of dextrin per day. Participants took 1 capsule twice a day for 4 weeks. For the Breathlessness, Cough, and Sputum Scale, the interaction between group and visit was statistically significant in a blend of analyses of variance. interleukin-8, tumor necrosis factor-α, and interferon-γ levels decreased more in the LP group than in the placebo group. The sample size required for large-scale clinical trials in the future was 50. There were no side effects. CONCLUSION: LP extract can enhance respiratory function. The detailed data we obtained support conducting the future main large-scale clinical trial.

The Effect of HIV/AIDS Infection on the Clinical Outcomes of COVID-19: A Meta-Analysis.

PURPOSE: Patients with HIV may be more likely to become severely ill from COVID-19. The present meta-analysis aims to determine the impact of HIV/AIDS infection on the clinical outcomes of COVID-19. METHODS: A comprehensive literature search was performed to identify relevant cohort studies to evaluate the association of HIV/AIDS infection with clinical outcomes of COVID-19. International databases, including PubMed (Medline), Web of Sciences, Scopus, and Embase, were searched from the emergence of the COVID-19 pandemic until January 2022. We utilized the risk ratio (RR) with its 95% confidence interval (95% CI) to quantify the effect of cohort studies. RESULTS: Twelve cohort studies were included in this meta-analysis, which examined a total number of 17,786,384 patients. Among them, 40,386 were identified to be HIV positive, and 17,745,998 were HIV negative. The pooled analyses showed HIV positive patients who were co-infected with SARS-CoV-2 were 58% more likely to develop a fever (RR=1.58; 95% CI: 1.42, 1.75), 24% more likely to have dyspnea (RR=1.24; 95% CI: 1.08, 1.41), 45% more likely to be admitted to ICU (RR=1.45; 95% CI: 1.26, 1.67), and 37% more likely to die from to COVID-19 (RR=1.37; 95% CI: 1.30, 1.45) than HIV negative patients. CONCLUSION: HIV/AIDS coinfection with COVID 19 increased the risk of fever, dyspnea, ICU admission, and mortality.

Progression of severity in coronavirus disease 2019 patients before treatment and a self-assessment scale to predict disease severity.

OBJECTIVES: This study aims to further investigate the association of COVID-19 disease severity with numerous patient characteristics, and to develop a convenient severity prediction scale for use in self-assessment at home or in preliminary screening in community healthcare settings. SETTING AND PARTICIPANTS: Data from 45,450 patients infected with COVID-19 from January 1 to February 27, 2020 were extracted from the municipal Notifiable Disease Report System in Wuhan, China. PRIMARY AND SECONDARY OUTCOME MEASURES: We categorized COVID-19 disease severity, based on The Chinese Diagnosis and Treatment Protocol for COVID-19, as "nonsevere" (which grouped asymptomatic, mild, and ordinary disease) versus "severe" (grouping severe and critical illness). RESULTS: Twelve scale items-age, gender, illness duration, dyspnea, shortness of breath (clinical evidence of altered breathing), hypertension, pulmonary disease, diabetes, cardio/cerebrovascular disease, number of comorbidities, neutrophil percentage, and lymphocyte percentage-were identified and showed good predictive ability (area under the curve = 0·72). After excluding the community healthcare laboratory parameters, the remaining model (the final self-assessment scale) showed similar area under the curve (= 0·71). CONCLUSIONS: Our COVID-19 severity self-assessment scale can be used by patients in the community to predict their risk of developing severe illness and the need for further medical assistance. The tool is also practical for use in preliminary screening in community healthcare settings. Our study constructed a COVID-19 severity self-assessment scale that can be used by patients in the community to predict their risk of developing severe illness and the need for further medical assistance.

Silent Hypoxia in COVID-19 Pneumonia: State of Knowledge, Pathophysiology, Mechanisms, and Management.

Patients with COVID-19 often present with life-threatening hypoxemia without dyspnea or signs of respiratory distress. Termed silent or happy hypoxia, it has puzzled clinicians and challenged and defied our understanding of normal respiratory physiology. A range of host- and pathogen-related factors appears to contribute to its development, including SARS-CoV-2's ability to produce different COVID-19 phenotypes; induce endothelial damage and elicit a vascular distress response; invade cells of the central nervous system and disrupt normal interoception and response; and modulate transcription factors involved in hypoxic responses. Because hypoxemia in COVID-19 is associated with increased mortality risk and poorer survival, early detection and prompt treatment is essential to prevent potential complications. Interventions to prevent hypoxemia and improve oxygen delivery to the blood and the tissues include home pulse-oximetry monitoring, optimization of patient positioning, judicious use of supplemental oxygen, breathing control exercises, and timely and appropriate use of ventilatory modalities and adjuncts.

Immunoglobulin signature predicts risk of post-acute COVID-19 syndrome.

Following acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a significant proportion of individuals develop prolonged symptoms, a serious condition termed post-acute coronavirus disease 2019 (COVID-19) syndrome (PACS) or long COVID. Predictors of PACS are needed. In a prospective multicentric cohort study of 215 individuals, we study COVID-19 patients during primary infection and up to one year later, compared to healthy subjects. We discover an immunoglobulin (Ig) signature, based on total IgM and IgG3 levels, which - combined with age, history of asthma bronchiale, and five symptoms during primary infection - is able to predict the risk of PACS independently of timepoint of blood sampling. We validate the score in an independent cohort of 395 individuals with COVID-19. Our results highlight the benefit of measuring Igs for the early identification of patients at high risk for PACS, which facilitates the study of targeted treatment and pathomechanisms of PACS.

More than 50 long-term effects of COVID-19: a systematic review and meta-analysis.

COVID-19 can involve persistence, sequelae, and other medical complications that last weeks to months after initial recovery. This systematic review and meta-analysis aims to identify studies assessing the long-term effects of COVID-19. LitCOVID and Embase were searched to identify articles with original data published before the 1st of January 2021, with a minimum of 100 patients. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were followed. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included (age 17-87 years). The included studies defined long-COVID as ranging from 14 to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.

Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients.

BACKGROUND: An intriguing feature recently unveiled in some COVID-19 patients is the "silent hypoxemia" phenomenon, which refers to the discrepancy of subjective well-being sensation while suffering hypoxia, manifested as the absence of dyspnea. OBJECTIVE: To describe the clinical characteristics and predictors of silent hypoxemia in hospitalized COVID-19 patients. METHODS: We conducted a prospective cohort study including consecutive hospitalized adult (≥ 18 years) patients with confirmed COVID-19 presenting to the emergency department with oxygen saturation (SpO2) ≤ 80% on room air from March 15 to June 30, 2020. We analyzed the characteristics, disease severity, and in-hospital outcomes of patients presenting with dyspnea and those without dyspnea (silent hypoxemia). RESULTS: We studied 470 cases (64.4% men; median age 55 years, interquartile range 46-64). There were 447 (95.1%) patients with dyspnea and 23 (4.9%) with silent hypoxemia. The demographic and clinical characteristics, comorbidities, laboratory and imaging findings, disease severity, and outcomes were similar between groups. Higher breathing and heart rates correlated significantly with lower SpO2 in patients with dyspnea but not in those with silent hypoxemia. Independent predictors of silent hypoxemia were the presence of new-onset headache (OR 2.919, 95% CI 1.101-7.742; P = 0.031) and presenting to the emergency department within the first eight days after symptoms onset (OR 3.183, 95% CI 1.024-9.89; P = 0.045). CONCLUSIONS: Patients with silent hypoxemia sought medical attention earlier and had new-onset headache more often. They were also likely to display lower hemodynamic compensatory responses to hypoxemia, which may underestimate the disease severity.

Epidemiological, clinical, and laboratory findings for patients of different age groups with confirmed coronavirus disease 2019 (COVID-19) in a hospital in Saudi Arabia.

BACKGROUND: Although the coronavirus disease 2019 (COVID-19) pandemic continues to rage worldwide, clinical and laboratory studies of this disease have been limited in many countries. We investigated the epidemiologic, clinical, and laboratory findings of COVID-19 infected patients to identify the effective indicators correlated with the disease. METHODS: A retrospective study was conducted at King Abdullah Hospital in Bisha Province, Saudi Arabia, from March 20 to June 30, 2020. Patients of different age groups were confirmed as having COVID-19 infection using a real-time polymerase chain reaction. The demographic, clinical, and laboratory data of the patients were statistically analyzed. RESULTS: Of the 132 patients, 85 were male and 47 were female, with a mean age of 50.9 years (SD±16.7). The patients were elderly (n = 29) and adults (n = 103). Of these, 54 (40.9%) had comorbidities, (25%) were admitted to the intensive care unit (ICU), and 12 (9.1%) died. On admission, the main clinical manifestations were fever (84.1%), cough (64.4%), shortness of breath (25%), chest pain (20.5%), and fatigue (18.2%). In all patients, increased neutrophils and decreased lymphocytes were observed. Patients' lactate dehydrogenase (LDH) was elevated. C-reactive protein (CRP) was elevated in 48.5%, D-dimer in 43.2%, and the erythrocyte sedimentation rate (ESR) in 40.9% of patients. The elderly showed higher neutrophil (p = 0.011) and lower lymphocyte (p = 0.009) counts than adults. Glucose, creatine kinase-MB, LDH, bilirubin, D-dimer, and ESR were significantly higher in the elderly than in the adults. The COVID-19 death group had a higher leucocyte count (p = 0.036), and higher urea (p = 0.029) and potassium (p = 0.022) than the recovered group but had a lower hemoglobin concentration (p = 0.018). A significant association was determined between COVID-19 death and the presence of cardiovascular disease (χ2(1) = 16.297, p<0.001), hypertension (χ2(1) = 12.034, p = 0.001), renal failure (χ2(1) = 3.843, p = 0. 05), old age (t (130) = 4.9, p <0.001), and ICU admission (χ2(1) = 17.6 (1), p<0.001). CONCLUSIONS: Investigating some of the laboratory and clinical parameters could help assess the disease progression, risk of mortality, and follow up patients who could progress to a fatal condition.

Clinical features and risk factors associated with morbidity and mortality among patients with COVID-19 in northern Ethiopia.

OBJECTIVE: To describe the clinical features and assess the determinants of severity and in-hospital mortality of patients with coronavirus disease 2019 (COVID-19) from a unique setting in Ethiopia. METHODS: Consecutive patients admitted to a COVID-19 isolation and treatment centre were included in this study. The overall clinical spectrum of COVID-19, and factors associated with risk of severe COVID-19 and in-hospital mortality were analysed. RESULTS: Of 2617 quarantined patients, three-quarters (n = 1935, 74%) were asymptomatic and only 114 (4.4%) presented with severe COVID-19. Common characteristics among the 682 symptomatic patients were cough (n = 354, 50.6%), myalgia (n = 212, 31.1%), headache (n = 196, 28.7%), fever (n = 161, 23.6%), dyspnoea (n = 111, 16.3%), anosmia and/or dysgeusia (n = 90, 13.2%), sore throat (n = 87, 12.8%) and chest pain (n = 77, 11.3%). Factors associated with severe COVID-19 were older age [adjusted relative risk (aRR) 1.78, 95% confidence interval (CI) 1.61-1.97; P < 0.0001], diabetes (aRR 2.00, 95% CI 1.20-3.32; P = 0.007), cardiovascular disease (aRR 2.53, 95% CI 1.53-4.17; P < 0.0001), malignancy (aRR 4.57, 95% CI 1.62-12.87; P = 0.004), surgery/trauma (aRR 23.98, 95% CI 10.35-55.57; P < 0.0001) and human immunodeficiency virus infection (aRR 4.24, 95% CI 1.55-11.61; P = 005). Factors associated with risk of in-hospital mortality included older age (aRR 2.37, 95% CI 1.90-2.95; P < 0.001), malignancy (aRR 6.73, 95% CI 1.50-30.16; P = 0.013) and surgery/trauma (aRR 59.52, 95% CI 12.90-274.68; P < 0.0001). CONCLUSIONS: A significant proportion of cases of COVID-19 were asymptomatic, and key comorbid conditions increased the risk of severe COVID-19 and in-hospital mortality. These findings could help in the design of appropriate management strategies for patients.

Hypereosinophilic syndrome with multiorgan involvement: an interdisciplinary work-up.

A previously healthy 40-year-old man was referred to our emergency department with pruritic skin lesions and dyspnoea. Laboratory investigation revealed hypereosinophilia. Further diagnostic work-up confirmed the diagnosis of idiopathic hypereosinophilic syndrome (iHES), a rare myeloproliferative disease with a heterogeneous clinical presentation. We describe a unique case with cardiac, pulmonary, hepatic and cutaneous involvement at time of presentation. This case accentuates the importance of an extensive multidisciplinary diagnostic work-up, since iHES is a condition with potential rapid progressive multiorgan failure which requires prompt analysis and treatment. In addition, this case emphasises the importance of being aware of tunnel vision, especially during the COVID-19 pandemic, which might give rise to an increased risk of missing rare diagnoses. Our patient was treated with prednisolone, after which both his clinical condition and eosinophil concentrations markedly improved.

Prevalence and correlates of chronic fatigue syndrome and post-traumatic stress disorder after the outbreak of the COVID-19.

As the SARS-COV-2 becomes a global pandemic, many researchers have a concern about the long COVID-19 complications. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a persistent, debilitating, and unexplained fatigue disorder. We investigated psychological morbidities such as CFS and post-traumatic stress disorder (PTSD) among survivors of COVID-19 over 6 months. All COVID-19 survivors from the university-affiliated hospital of Tehran, Iran, were assessed 6 months after infection onset by a previously validated questionnaire based on the Fukuda guidelines for CFS/EM and DSM-5 Checklist for PTSD (The Post-traumatic Stress Disorder Checklist for DSM-5 or PCL-5) to determine the presence of stress disorder and chronic fatigue problems. A total of 120 patients were enrolled. The prevalence rate of fatigue symptoms was 17.5%. Twelve (10%) screened positive for chronic idiopathic fatigue (CIF), 6 (5%) for CFS-like with insufficient fatigue syndrome (CFSWIFS), and 3 (2.5%) for CFS. The mean total scores in PCL-5 were 9.27 ± 10.76 (range:0-44), and the prevalence rate of PTSD was 5.8%. There was no significant association after adjusting between CFS and PTSD, gender, comorbidities, and chloroquine phosphate administration. The obtained data revealed the prevalence of CFS among patients with COVID-19, which is almost similar to CFS prevalence in the general population. Moreover, PTSD in patients with COVID-19 is not associated with the increased risk of CFS. Our study suggested that medical institutions should pay attention to the psychological consequences of the COVID-19 outbreak.

The independent factors associated with oxygen therapy in COVID-19 patients under 65 years old.

BACKGROUND: The number of hospitalized young coronavirus disease 2019 (COVID-19) patients has increased significantly. However, specific data about COVID-19 patients under 65 years old who are admitted to the hospital are scarce. METHODS: The COVID-19 patients under 65 years old who were admitted to the hospital in Sichuan Province, Renmin Hospital of Wuhan University, and Wuhan Red Cross Hospital were included in this study. Demographic information, laboratory data and clinical treatment courses were extracted from electronic medical records. Risk factors associated with oxygen therapy were explored. RESULTS: Eight hundred thirty-three COVID-19 patients under 65 years old were included. Of the included patients, 29.4% had one or more comorbidities. Oxygen therapy was required in 63.1% of these patients, and the mortality was 2.9% among the oxygen therapy patients. Fever (odds ratio [OR] 2.072, 95% confidence interval [CI] 1.312-3.271, p = 0.002), dyspnea (OR 2.522, 95% CI 1.213-5.243, p = 0.013), chest distress (OR 2.278, 95% CI 1.160-4.473, p = 0.017), elevated respiratory rate (OR 1.114, 95% CI 1.010-1.228, p = 0.031), and decreased albumin (OR 0.932, 95% CI 0.880-0.987, p = 0.016) and globulin levels (OR 0.929, 95% 0.881-0.980, p = 0.007) were independent factors related to oxygen therapy. CONCLUSIONS: Oxygen therapy is highly required in COVID-19 patients under 65 years old who are admitted to the hospital, but the success rate is high. Respiratory failure-related symptoms, elevated respiratory rate, low albumin and globulin levels, and fever at admission are independent risk factors related to the requirement of oxygen.

Neurological features and outcome in COVID-19: dementia can predict severe disease.

The COVID-19 pandemic has infected more than 22 million people worldwide. Although much has been learned about COVID-19, we do not know much about its neurological features and their outcome. This observational study was conducted on the patients of Imam Hossein Hospital, and 361 adult patients (214 males) with confirmed diagnosis of COVID-19 from March 5, 2020 to April 3, 2020, were enrolled. Data was gathered on age, sex, comorbidities, initial symptoms, symptoms during the disease course, neurological symptoms, and outcome. The mean age of the patients was 61.90 ± 16.76 years. The most common initial symptoms were cough, fever, and dyspnea. In 21 patients (5.8%), the initial symptom was neurological. History of dementia was associated with severe COVID-19 disease (odds ratio = 1.28). During the course of the disease, 186 patients (51.52%) had at least one neurological symptom, the most common being headache (109 [30.2%]), followed by anosmia/ageusia (69, [19.1%]), and dizziness (54, [15%]). Also, 31 patients had neurological complications (8.58%). Anosmia, ageusia, dizziness, and headache were associated with favorable outcome (P < 0.001), while altered mental status and hemiparesis were associated with poor outcome. The mortality rate of patients who had neurological complications was more than twice than that of patients without neurological complication (P = 0.008). Almost half of the patients experienced at least one neurological symptom, which may be the initial presentation of COVID-19. Dementia appears to be associated with severe COVID-19. Mortality was higher in patients with neurological complications, and these patients needed more intensive care.